Fistula
In medicine, a
fistula (pl. fistulas or fistulae) is an abnormal connection or passageway between organs or vessels that normally do not connect.
Location of fistulas
Fistulas can develop in various parts of the body, including:
- Anorectal: connecting the rectum or other anorectal area to the skin surface. This results in abnormal discharge of feces through an opening other than the anus. Also called fistula-in-ano.\n*Arteriovenous or A-V: between an artery and vein\n*Biliary: connecting the bile ducts to the skin surface, often caused by gallbladder surgery\n*Cervical: abnormal opening in the cervix\n*Craniosinus: between the intracranial space and a paranasal sinus\n*Enteroenteral: between two parts of the intestine\n*Enterocutaneous: between the intestine and the skin surface\n*Enterovaginal: between the intestine and the vagina\n*Fecal: see Anorectal\n*Fistula-in-ano: see Anorectal\n*Gastric: from the stomach to the skin surface\n*Metroperitoneal: between the uterus and peritoneal cavity\n*Perilymph: tear between the membranes between the middle and inner ears\n*Pulmonary arteriovenous: between an artery and vein of the lungs, resulting in shunting of blood. This results in improperly oxygenated blood\n*Rectovaginal: between the rectum and the vagina\n*Umbilical: between the umbilicus and gut\n*Tracheoesophageal: between the breathing and the feeding tubes\n*Vesicovaginal: between the bladder and the vagina
Types of fistulas
Various types of fistulas include:
- Blind: with only one open end\n*Complete: with both external and internal openings\n*Incomplete: a fistula with an external skin opening, which does not connect to any internal organ
Although most fistulas are in forms of a tube, some can also have multiple branches.
Causes
Various causes of fistula are:
- Diseases: Inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis, are the leading causes of anorectal, enteroenteral, and enterocutaneous fistulas.
- Medical treatment: Complications from gallbladder surgery can lead to biliary fistula. Radiation therapy can lead to vesicovaginal fistula.
- Trauma: Head trauma can lead to perilymph fistulas, whereas trauma to other parts of the body can cause arteriovenous fistulas. Obstructed labor can lead to vasicovaginal and rectovaginal fistulas.
\nTreatment
Treatment for fistulae varies depending on the cause and extent of the fistula, but often involves surgical intervention combined with antibiotic therapy.
Typically the first step in treating a fistula is an examination by a doctor to determine the extend and "path" that the fistula takes through the tissue.
Surgery is often required to assure adequate drainage of the fistula (so that pus may escape without forming an abscess). Various surgical procedures are commonly used, most commonly fistulotomy, placement of a seton (a cord that is passed through the path of the fistula to keep it open for draining), or an endorectal flap procedure (where healthy tissue is pulled over the internal side of the fistula to keep feces or other material from reinfecting the channel). Surgery for anorectal fistulae is not without side effects, including recurrence, reinfection, and incontinence.
It is important to note that surgical treatment of a fistula without diagnosis or management of the underlying condition, if any, is not recommended. For example, surgical treatment of fistulae in Crohn's disease can be effective, but if the Crohn's disease itself is not treated, the rate of recurrence of fistula is very high (well above 50%).
See also
\n*Anastomosis
External links
\n*Cleveland Clinic - Anorectal Fistula\n*Hemorrhoids In Plain English - Fistula-in-Ano\n*Mayo Clinic - Arteriovenous Fistula\n*American Urological Association - Bladder Fistula\n*American Hearing Research Foundation - Perilymph Fistula\n*The Fistula Foundation - Obstetric Fistulas\n*Fistula Hospital in Ethiopia
